Issue Of Blood Research Articles

Postoperative Outcomes and One-Year Mortality of Patients on Chronic Anticoagulation Medications Undergoing Infrainguinal Bypass

Patients requiring open infrainguinal bypass (IIB) frequently are taking chronic anticoagulation (AC) medications. Taking these medications in the preoperative setting may affect the outcomes of surgery. This study aims to evaluate postoperative outcomes and 1-year mortality of patients taking chronic AC medications that undergo IIB. Using data obtained from the Vascular Quality Initiative from January 2011 to October 2021, patients on warfarin or any direct oral anticoagulants (DOAC) within 30days of IIB were compared with patients not taking chronic AC medications. The primary outcomes were in-hospital, 30-day, and 1-year mortality. The secondary outcomes included total procedure time, need for perioperative packed red blood cell transfusion, prolonged length of hospital stay, postoperative myocardial infarction or stroke, and graft patency at discharge. A subgroup analysis was performed comparing patients taking warfarin with those taking DOACs. Univariate analyses and multivariate logistic regression, Kaplan Meier survival, and Cox regression analyses were used to analyze the data for postoperative and 1-year outcomes, respectively. A total of 55,076 patients underwent IIB during the study period, and 11,547 (20.97%) were on chronic AC prior to surgery. The 2 cohorts differed significantly in almost every demographic and clinical characteristic. Multivariate analyses adjusting for 45 potential confounders revealed that there was no significant difference in in-hospital, 30-day, and 1-year mortality. The total procedure time for the chronic AC cohort was on average 11.46±2.16min longer (P ≤ 0.001) and there was a greater risk of prolonged length of stay in the hospital (adjusted odds ratio [aOR]: 1.19, 95% confidence interval [CI]: 1.13-1.26, P<0.001). These patients also returned to the operating room (OR) at a greater rate (aOR: 1.12, 95% CI: 1.05-1.19; P=0.016) and demonstrated a significantly lower rate of graft patency at discharge (aOR: 0.73, 95% CI: 0.62-0.86, P=0.001). On subgroup analysis, multivariate analysis demonstrated lower 30-day mortality for the DOAC group in comparison to the warfarin group (aOR: 0.74, 95% CI: 0.57-0.94, P=0.015), but no significant differences in in-hospital and 1-year mortality. Patients taking AC medications within 30days prior to IIBs may require more perioperative red blood cell transfusions, longer hospitalizations, and return to the OR at a greater rate. They are also at an increased risk for loss of graft patency at discharge. However, these patients are not at increased risk of in-hospital, 30-day, or 1-year mortality. IIB can, therefore, be performed safely in patients taking chronic AC medications.

A Retrospective Analysis of Venographic Images of a Central Venous Port without Blood Return and Its Usable Period.

Objective In routine practice, central venous ports without blood return (CVPWBRs) are common. However, very few studies have reported on the viable period of CVPWBR use. We therefore investigated this period by retrospectively analyzing the venographic images of CVPWBRs. Methods We examined patients' venography through the CVPs at the point when they became CVPWBRs for the first time and analyzed the reasons for becoming CVPWBRs. For patients with minor complications of CVPs or normal venographic findings, we used the Kaplan-Meier method to evaluate the period for which such CVPWBRs could be used. Patients or Materials Eighty-four patients with malignancy whose CVPs became CVPWBRs for the first time between July 31, 2015, and March 12, 2020, were included. Results Nine (10.7%) patients had major complications that made the CVPs unusable. Thirty-three (39.3%) patients had minor complications, and the remaining 42 (50.0%) had normal venographic findings. For the 75 patients with minor complications or normal venographic findings who continued to use their CVPWBRs, the Kaplan-Meier method estimated that 25% of complications that might make it unusable would occur within 1,273 days. Conclusion There are two learning points in our study. First, venography is needed when the CVP becomes a CVPWBR for the first time due to the high risk, and second, CVPWBRs can be used for a relatively long period in patients without major complications. It is necessary to develop an appropriate follow-up management method for CVPWBRs in prospective studies.

Application of StyleGAN Architecture for Generating Venous Leg Ulcer Images.

Leg ulcers caused by impaired venous blood return are the most typical chronic wound form and have a significant negative impact on the lives of people living with these wounds. Thus, it is important to provide early assessment and appropriate treatment of the wounds to promote their healing in the normal trajectory. Gathering quality wound data is an important component of good clinical care, enabling monitoring of healing progress. This data can also be useful to train machine learning algorithms with a view to predicting healing. Unfortunately, a high volume of good-quality data is needed to create datasets of suitable volume from people with wounds. In order to improve the process of gathering venous leg ulcer (VLU) data we propose the generative adversarial network based on StyleGAN architecture to synthesize new images from original samples. We utilized a dataset that was manually collected as part of a longitudinal observational study of VLUs and successfully synthesized new samples. These synthesized samples were validated by two clinicians. In future work, we plan to further process these new samples to train a fully automated neural network for ulcer segmentation.

Effect of pomegranate (Punica granatum) peel powder supplementation on performance, carcass characteristics and haemato-biochemical parameters of broiler chickens

The present study was conducted to evaluate the effect of pomegranate peel powder (PPP) supplementation on growth performance, carcass characteristics, haemato-biochemical parameters and return over feed cost in broiler chickens. A total of 240 unsexed day-old broiler chicks were randomly allocated into four treatment groups with four replicates in each. The control group (T1) was fed with a standard basal diet as per BIS (2007). Groups T2, T3, and T4 were fed the basal diet with 0.25, 0.5 and 1.0 % level of PPP, respectively for six weeks. Results revealed that the mean final body weight and body weight gain were significantly higher in T4 as compared to the other dietary treatments. The feed conversion ratio was better in T4 and T3 groups as compared to the T1 and T2 groups. There were no differences in carcass characteristics among the dietary treatments. The serum concentration of triglycerides and cholesterol were significantly reduced in T4 and T3 groups as compared to the control. The return over feed cost was higher T3 and T4 groups than the control group. Thus, it can be concluded that dietary supplementation of 1% pomegranate peel powder improved growth performance, production efficiency, blood lipid profile and return over feed cost in broiler chickens.

Chronic Venous Disease and Its Intersections With Diabetes Mellitus.

Chronic venous disease (CVD) is a vascular disorder in which blood return is severely compromised and CVD is usually characterized by venous hypertension. Along with obesity and diabetes mellitus, CVD is one of the most common civilization diseases. In general, the estimated prevalence of CVD ranges from 60-80 %. Early diagnosis and adequate treatment are important for preventing progression to more severe stages of the disease like venous leg ulcers. Clinical manifestations of CVD in initial stages of the disease are often asymptomatic. However, as CVD progresses, symptoms begin to develop. Treatment of CVD could be divided into conservative and surgical. Conservative therapy consists of compression, pharmacological treatment and lifestyle change. In cases where conservative therapy is ineffective, surgical or endovascular treatment may be required. The intersections between diabetes mellitus (DM) and CVD are not to be underestimated. CVD and DM have often the same risk factors. Symptoms of CVD can be modified by late complications of DM, but the incidence of different CVD degrees seems to be the same as in diabetics as in non-diabetics population. We are particularly concerned in diabetics about worse compliance with treatment due to their often-poorer adherence to treatment of DM and lifestyle changes. Moreover, there exist a higher risk of CVD and peripheral arterial disease in diabetics patients. Patients with CVD should always be inspected for the presence of DM, considering its presence can have a bearing on CVD symptoms, diagnostic procedures, and therapeutic strategies.

Socialization of The Emotional Effect of Freedom Technique on The Anxiety of Pre-Percutaneous Coronary Intervention Patients in The Hospital Grandmed Lubuk Pakam

Coronary heart disease (CHD) is a health disorder in the cardiovascular system where cases have a mortality rate of 6.7 million cases in 2018. CHD is a dangerous disease in the Southeast Asian region, including Indonesia. The prevalence of CHD in North Sumatra is 0.5%. Percutaneous Coronary Intervention (PCI) action is a technique to open blood vessels and return blood through the coronary arteries. In carrying out proper PCI operations, interventions are needed that can reduce the anxiety of pre-PCI patients, namely The Emotional Freedom Technique (EFT). Service activities are carried out through outreach activities through several methods of lectures, discussions, and questions and answers. The number of participants in this PkM activity was 15 nursing staff at the Lubuk Pakam Grandmed Hospital. The sample was determined using a random sampling technique, where the sample of male nursing staff was 4 people and 11 female nursing staff. The activity begins with giving a pre-test and ends with a post-test. The results of the dedication show that the level of anxiety can be reduced by administering Emotional Freedom Technique (EFT) therapy. The percent increase in knowledge of the largest and smallest PkM participants is 25% and 15%. The average value of increasing the knowledge of PkM participants after being given socialization was 20%. This socialization activity has succeeded in providing benefits for PkM participants in increasing PkM participants' knowledge about the effect of EFT.

Application of targeted training in reducing the incidence of blood return in the placement of indwelling needle

Application of targeted training in reducing the incidence of blood return in the placement of indwelling needle

A rare presentation of Sintilimab-induced swelling along the vessels: Case report.

Immune-related adverse events are occasionally reported in Sintilimab treatment. This study reports a forward and reverse swelling case along the vein after infusion of Sintilimab. At present, swelling along the vascular direction during peripheral infusion are limitedly reported at home and abroad, especially when choosing a vein with thick, elastic, and good blood return. A 56-year-old male who suffered from esophageal cancer and liver cancer and received albumin-bound paclitaxel and nedaplatin chemotherapy in combination with Sintilimab immunotherapy appeared swelling along the vessel after infusion of Sintilimab. The patient was punctured 3 times. Sintilimab-induced vascular edema may be a side effect resulted from a combination of variables such as relatively poor vascular function of the patient, chemical extravasation, allergic skin reactions, venous valves, vascular intima, and diameter stenosis. Sintilimab rarely causes vascular edema only when drug allergic reaction is the underlying factor. As only a few cases of vascular edema caused by Sintilimab have been reported, causes to such a drug-induced vascular edema remained unclear. The swelling was controlled by an intravenous specialist nurse according to delayed extravasation treatment and the doctor anti-allergy treatment, but the uncertainty of repeated puncture and symptom diagnosis caused pain and anxiety to the patient and his family. The symptom of swelling was gradually relieved after the anti-allergic treatment. The patient completed the following drug infusion without discomfort after the third puncture. When the patient was discharged the next day, swelling in his both hands disappeared, and the patient had no anxiety or discomfort. The side effects of immunotherapy may accumulate over time. Early identification and appropriate nursing management are the keys to minimizing patients' pain and anxiety. To effectively treat symptoms, nurses could benefit from quickly identifying the source of swelling.

Intraoperative blood auto-transfusion restrained the malignancy of Liver Cancer via regulating functions of tumor cells and Kuffer cells

ABSTRACT The role of IBA in regulating the recovery of liver cancer was investigated using a rat model of liver cancer and an intraoperative blood return model (IBA). SD rats were used to construct the IBA model. Kupffer cells were isolated from liver cancer tissues, and their biological characteristics were analyzed by flow cytometry. Comet assay was used to detect DNA damage in tumor cells; clone formation assay and transwell assay were used to detect tumor cell proliferation and migration ability. Western blot analysis was used to determine the changes in related signaling pathways. After the IBA treatment, the production of KCs was significantly promoted in rat liver cancer tissues, and the expression levels of cell cycle arrest proteins P53, AEN and CDKN1A were also significantly increased. In tumor cells, IBA induced cell cycle arrest and cellular DNA damage in a p53-mediated manner. In addition, the proliferation and migration of cancer cells were also significantly inhibited. Similar to the in vivo data, the expression of TP53, AEN and CDKN1A was also up-regulated. Our study showed that IBA can inhibit the malignant transformation of hepatocellular carcinoma by modulating the function-dependent p53-mediated pathway of tumor cells and KCs.

Effect of Kegel Exercise and Prone Position on Spasmodic Pain and Involution of Uterus Among Postnatal Mothers

Following delivery, women may feel a variety of pains and discomforts, including cramping pain brought on by uterine involution, in which the uterus contracts to stop blood loss and return to its pre-pregnancy size. This study examined the impact of kegal exercise and the prone posture on postpartum moms' spasmodic discomfort and uterine involution. “The research design selected for the study was pre experimental research design”. “Non Probability purposive sampling techniques” were used to collect 60 postnatal mothers. “Numerical pain rating scale to assess pain and clinical proforma to assess involution of uterus” was administered to conduct the pre-test and the post test. Each sample received the Kegel exercise (10 secs three times per day for three days) and the prone position (3 to 5 mints three times per day for three days) after the pretest pain and fundal height levels were evaluated. After three days, the same scale was used to assess pain and fundal height. The mean scores for the fundal height and pain pre-tests were 7.66 and 7.83, respectively. Post-test mean scores for fundal height and pain were 3.86 and 4.1, respectively. The pre-test fundal height and pain score had standard deviations of 1.77 and 1.37, and the post-test fundal height and pain score had standard deviations of 1.86 and 2.00. Age, educational attainment, and age of menarche were important factors in the calculated chi square value, but other variables were insignificant. The study's findings supported the notion that the prone posture and the Kegel exercise helped postpartum mothers' fundal height and pain.

Effect Of Emotional Freedom Technique On Pre Percutaneous Coronary Intervention Patients' Anxiety In Hospital

Coronary heart disease is a degenerative disease. One of the techniques that can open blood vessels and return blood through the coronary arteries is Percutaneous Coronary Intervention (PCI). Hemodynamic conditions are one of the patient's preparations for PCI, but anxiety can respond to the cardiovascular system, one of which is a disturbance in a person's hemodynamics. Problems that often arise in pre PCI patients are anxiety.Percutaneous Coronary Intervention is one of the techniques that have been invented to open the blood vessels and return blood through the coronary arteries (PCI). PCI, also known as cardiac catheterization, is a procedure that involves inserting one or more catheters into the heart and blood arteries. The catheter is inserted through a peripheral vessel, usually femoral, then non-operatively invasive so that complications can be kept as low as possible. Percutaneous Coronary Intervention (PCI) can cause complications in the form of myocardial infarction, stroke, arrhythmia and death. This causes a person to feel himself threatened, someone feels himself threatened can cause the effect of Anxiety (anxiety). The problem that often arises in pre PCI patients is anxiety. One of the efforts to overcome anxiety is the Emotional Freedom Technique (EFT). This type of research is a quantitative study using a quasi-experimental design with a pretest-posttest with a control group, namely by conducting a pretest in both groups and followed by an intervention in the experimental group and then conducting a posttest in both groups, with a sample of 34 respondents. The results showed that the effect of EFT on the anxiety of pre PCI patients in the intervention group with p-value = 0.000, while in the control group with p-value = 0.650. Furthermore, it is hoped that clients who will undergo PCI will not be hindered from doing PCI because the client has been given Emotional Freedom Technique (EFT) therapy.

Aspiration before tissue filling with hyaluronic acid-safety enhancement by using a lidocaine-primed syringe.

Most of the doctors would regularly aspirate the plunger of a syringe before injection to make sure that the needle would not be mis-inserted into vessels. Yet pulling the plunger back only cannot guarantee the injecting status is safe. Injecting all of the non-fluid fillers, including colloidal hyaluronic acid (HA) into the vessel may cause "No blood return while pulling back the plunger," which is defined as false-negative aspiration. In the first experiment, HA syringes were inserted into vessel simulators in vitro with standard needle sizes and residual dosages. In the second experiment, the lidocaine-primed syringe were inserted into the vessel simulator instead to observe its aspiration. There was no difference using different sizes of needles or dosages except for group 0.1 mL and the lidocaine-primed syringe. The rest of the groups need to wait more seconds to observe the blood return. The time lag does exist in every single aspiration and 88% of the blood return would happen in 10 s. We suggested that operators should aspirate regularly before giving an injection with at least 10 s of waiting or use the lidocaine-primed syringe instead. Blood returns could mostly be recognized in both ways.

Clinical efficacy of enhanced external counter pulsation plus sacubitril/valsartan in the treatment of patients with chronic heart failure and the effect on ankle-arm index and cardiac function.

The aim of this study was to evaluate the clinical efficacy of enhanced external counter pulsation (EECP) plus sacubitril/valsartan in the treatment of patients with chronic heart failure (CHF) and the effect on ankle-arm index and cardiac function. In this retrospective study, 106 patients with chronic heart failure treated in our hospital from September 2020 to April 2022 were recruited and randomly assigned to receive either sacubitril/valsartan (observation group) or EECP plus sacubitril/valsartan (combination group) alternately at the point of admission, with 53 patients in each group. Outcome measures included clinical efficacy, ankle brachial index (ABI), cardiac function indices [N-terminal brain natriuretic peptide precursor (NT-proBNP), 6 min walking distance (6MWD), left ventricular ejection fraction (LVEF)], and adverse events. EECP plus sacubitril/valsartan resulted in significantly higher treatment efficiency and ABI levels vs. sacubitril/valsartan (p<0.05). Patients receiving combined therapy showed significantly lower NT-proBNP levels than those given monotherapy (p<0.05). EECP plus sacubitril/valsartan resulted in longer 6MWD and higher LVEF than sacubitril/valsartan alone (p<0.05). No significant differences were observed in the adverse events between the two groups (p>0.05). EECP plus sacubitril/valsartan substantially improves the ABI levels, cardiac functions, and exercise tolerance of patients with chronic heart failure, with a high safety profile. EECP improves blood supply to myocardial ischemic tissues by increasing ventricular diastolic blood return and blood perfusion to ischemic myocardium, raises aortic diastolic pressure, restores pumping function, improves LVEF, and reduces NT-proBNP secretion.

Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter

Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; &gt; 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P &lt; 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P &lt; 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.

Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter

Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; &gt; 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P &lt; 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P &lt; 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.

Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis.

Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention. The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p< .001), resulting in an estimated savings of 8.9h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p< .001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p< .001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year. Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.

Effects of traditional Chinese exercise on vascular function in patients with Alzheimer's disease: A protocol for systematic review and network meta-analysis of randomized controlled trials.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder with an insidious onset, usually characterized by memory impairment, visual-spatial skill impairment, executive dysfunction and personality behavioral changes. Studies have confirmed that vascular dysfunction may precede AD pathological changes and can present as vascular malformations, atherosclerosis, and impaired self-regulation, and can affect oxidative stress and amyloidosis. Therefore, it is important to improve or prevent vascular dysfunction in AD patients. Regular exercise can effectively inhibit the production of reactive oxygen species during the occurrence of AD and can improve the reduction of cerebral blood flow due to AD. Previous studies have shown that exercise can achieve superior clinical results in improving vascular function in AD patients. Therefore, we hypothesize that traditional Chinese exercises (TCEs) may have a good clinical effect in improving vascular function in patients with AD. We will search "PubMed," "the Cochrane Library," "Embase," "Web of Science," "CINAHL," "ProQuest Dissertations and Theses," and "ProQuest-Health & Medical Collection," "CNKI," "SinoMed," "VIP," and "Wanfang Data" to find randomized controlled trials of the effects of TCEs on AD vascular function from the creation of the database to the present, including at least 1 indicator in carotid intima-media thickness (cIMT), middle cerebral artery mean flow velocity (MFV), blood indicators [Heme Oxidase-1 (HO-1), angiopoietin I (Ang I), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor, matrix metalloproteinase-9 (MMP-9)], and arterial stiffness [(Ankle Brachial Index (ABI), pulse wave velocity (PWV)]. For the included literature, Excel 2019 will be used for data extraction and collection. For the indicators that can be netted for network meta-analysis, Surface Under the Cumulative Ranking for each exercise modality will be calculated with the help of Stata 16.0 and rank, where the higher the SUCRA score, the higher the ranking. For the indicators that cannot be netted, Review Manager 5.4 will be used for meta-analysis will be performed to evaluate the improvement effect of TCEs on AD patients. This meta-analysis will further determine the efficacy and safety of TCEs on vascular function in AD patients. In this study, randomized controlled trials of the effects of TCEs on vascular function in AD patients will be selected to provide evidence-based medical evidence for promoting the application of TCEs by observing the order of advantages and disadvantages of various exercise modalities through network meta-analysis.

Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

ObjectivesTo observe if blood return, also defined as the blood infusion test (BIT) could predict fluid responsiveness in critically ill patients with acute circulatory failure and renal replacement therapy (RRT).MethodsThis was a single-center, prospective, diagnostic accuracy study. Before BIT, the passive leg raise test (PLRT) was performed to record the change of cardiac output (ΔCO) by pulse contour analysis, and ΔCO > = 10% was defined as the fluid responder. Meanwhile, the change in velocity time integral (ΔVTI) was recorded by ultrasound. Later, the ΔCO and ΔVTI during BIT were recorded 5–10 min after PLRT. The receiver-operating characteristic curves of ΔCO and ΔVTI of BIT were performed in predicting the fluid responder defined by PLRT.ResultsA total of 43 patients with acute circulatory failure undergoing RRT were enrolled in the present study, and 25 patients (58.1%) were recognized as responders during PLRT. According to the receiver-operating characteristic curves, the cutoff value of ΔCO was 10% and ΔVTI was 9% during BIT with the area under curve of 0.96 and 0.94, respectively.ConclusionsBIT in RRT could identify fluid responsiveness in critically ill patients with shock.Trial registrationChiCTR-DDD-17010534. Registered on 30/01/2017 (retrospective registration).

Venous chambers in clinical use for hemodialysis have limited capacity to eliminate microbubbles from entering the return bloodline: An in vitro study.

During hemodialysis (HD), blood passes through an extracorporeal circuit (ECC). To prevent air administration to the patient, a venous chamber (chamber) is located before the blood return. Microbubbles (MBs) may pass through the chamber and end up as microemboli in organs such as the brain and heart. This in vitro study investigated the efficacy of various chambers in MB removal. The in vitro recirculated setting of an ECC included an FX10 dialyzer, a dextran-albumin solution to mimic blood viscosity and chambers with different flow characteristics in clinical use (Baxter: AK98 and Artis, Fresenius: 5008 and 6008) and preclinical test (Embody: Emboless®). A Gampt BCC200 device measured the presence and size of MBs (20-500 μm). Percentage change of MBs was calculated: ΔMB%=100*(outlet-inlet)/inlet for each size of MB. Blood pump speed (Qb) was 200 (Qb200) or 300 (Qb300) ml/minute. Wilcoxon paired test determined differences. With Qb200 median ΔMB% reduction was: Emboless -58%, AK98 -24%, Fresenius 5008 -23%, Artis -8%, and Fresenius 6008 ± 0%. With Qb300 ΔMB% was: Emboless -36%, AK98 ± 0%, Fresenius 5008 ± 0%, Artis +25%, and Fresenius 6008 + 21%. The Emboless was superior to all other chambers with Qb200 and Qb300 (p < 0.001). Further, the Emboless with Qb300 still eliminated more MBs than all other chambers with Qb200 (p ≤ 0.003). The results from the present study indicate that flow characteristics of the chamber and the Qb are important factors to limiting exposure of MB to the return bloodline. The Emboless chamber reduced MBs more effective than those chambers in clinical use investigated.

Do not trust landmarks and your feelings while inserting pediatric central venous catheters

BackgroundCentral venous catheterization (CVC) is a commonly used procedure in pediatric surgery and intensive care units. For some reasons, catheterizations in children are technically more difficult in comparison to adult patients. The purpose of this study is to evaluate the CVC procedures performed with the aid of anatomic landmarks by experienced (35, 14, 4 years of experience) anesthesiologists and the associated complications. A total of 498 cases under the age of 18 who underwent CVC (temporary, port, or Hickman) between the years 2014 and 2017 were included in this retrospective study. All catheters were inserted with the aid of anatomic landmarks.ResultsThe mean age of the patients was 47.1 ± 59.2 months and 54.8% were male. By using anatomical landmarks, the average success rate in central venous catheterizations was calculated as 98.6%. Complications developed included arterial puncture in 8% (n 40), temporary arrhythmia in 6.2% (n 31) and pneumothorax in 1.4% (n 7) of the patients. Only using multiple punctures (p = 0.005) and catheterizations lasting more than 10 min (the time to blood return from the catheter, p = 0.017) were found to be associated with complications. The experience of the practitioner had no effect on the development of complications (p = 0.354).ConclusionsIn CVCs using anatomic landmarks, complications are seen more frequently in children. Even though a decrease in overall complication rates was detected in catheterizations performed by experienced hands, it is seen that experience does not eliminate complications in CVC insertions using anatomic landmarks.